No other specialty sees residents commonly doing 2-3 fellowships

[tensoranalysis]

---

Members don't see this ad.

Pathology is the only residency where you could be a really good resident by just being an excellent assistant.

The variation in competency among residents and fellows is astounding. I'd argue the reason we see so much variation is that medical school provides little in the way of a foundation for training in pathology. For other subspecialties, medical school prepares you to be a resident, but how many of you can say that medical school did that for you for pathology?

If you choose a residency in pathology, be aware that the field is so vast and unlike medical school that you should expect to set your training clocks back to zero. I think this is a harsh reality for most of us that have delayed gratification for so long, but important to set the expectation as such until medical school gives the attention to our field it deserves. Especially if everyone expects this field to stick around.

 

[yaah]

The variation in competency among new graduates and even practicing pathologists is also quite astounding. You learn a lot from doing CAP inspections and going to state path meetings about the spectrum of practice out there. I don't know if it's because there are some bad training programs out there or some trainees are able to slip through the cracks, but a lot of it is simply just attitude and personality. The above post is right about being a really good resident just by being a hard worker and paying attention - it's ever amazing to me how many people can't do this in every branch of medicine and in every part of the hospital (doctors and non-doctors alike).

 

[pathslides]

You guys really helped me steer away from path with these threads. The number of fellowships a new doc should have to do to get a job is 0-1.

if you actually liked path and used a stupid forum to influence you over doing your own due diligence by rotating and talking with path attendings, that is pretty sad.

1 fellowship is a necessity. If you go to a good program with good volume and variability and work hard, 2 fellowships are not needed, especially for community practice. 3 fellowships is ludicrous and 99% of the time it is due to multiple red flags in a candidate.

 

[deleted978973]

if you actually liked path and used a stupid forum to influence you over doing your own due diligence by rotating and talking with path attendings, that is pretty sad.

1 fellowship is a necessity. If you go to a good program with good volume and variability and work hard, 2 fellowships are not needed, especially for community practice. 3 fellowships is ludicrous and 99% of the time it is due to multiple red flags in a candidate.

I really do like path, but for me the risks involved with going into the field are just way too big.

 

[yaah]

But the risks involved with going into medicine itself are not? The perspective of some of you folks is quite whacky.

 

[CDX-2]

Pathology is the only residency where you could be a really good resident by just being an excellent assistant.

The variation in competency among residents and fellows is astounding. I'd argue the reason we see so much variation is that medical school provides little in the way of a foundation for training in pathology. For other subspecialties, medical school prepares you to be a resident, but how many of you can say that medical school did that for you for pathology?

Agree. However I also think that part of the variation in competency among residents / registrars (for AP at least) is also due to the variation in the labs (casemix) and the work environment (in particular staffing levels, and the people you work with).

You can have rural labs that don't receive specimens of certain subspecialties (eg Neuro, Hepatobiliary, Head & Neck), so somebody placed there won't get as much grossing or reporting experience for Meningiomas / Whipple's / Laryngectomies compared to someone matched to a city / tertiary lab. That's not the registrar / resident's fault, that's just the case-mix for that lab.

With regards to work environment, my previous lab was very understaffed to the point where I was (very cooperatively but naively at the time) doing stuff that really should be done by lab techs / scientists, such as accessioning and cassette-printing, specimen throwout and manual defat (defat processing machine broke down and the lab apparently didn't have the budget to repair it for that calendar year, so we had to routinely prepare buckets with alcohol and xylene and change the liquids every 3 hours) ON TOP of grossing large specimens and biopsies, which severely compromised my reporting time while I was there. Hence I was the only person in my original AP cohort who was definitely unable to sit board exams this year as I was ridiculously behind in histology knowledge.

Thankfully I've moved on to a different lab where I have to do grossing 5 days / week, but without having to do lab tech / scientist tasks. I'm now learning more histology here, and I've also looked at / practiced reporting more cases here in nearly 12 months (in fact more than double), than I did in my previous lab in 2 years. It'd be nice if I didn't have to gross 5 days / week, but relatively-speaking, it's already big step up from my previous lab...

 

[D1b()4]

More than 1 fellowship is unnecessary to get a good job. Everyone I know at my program, including myself, has not had difficulty finding a job after doing only one fellowship.

 

[D1b()4]

You guys really helped me steer away from path with these threads. The number of fellowships a new doc should have to do to get a job is 0-1.

Keep in mind that fellowships in other fields can last several years. Overwhelming majority of pathology fellowships take only a year to complete.

 

[dermpathdoc]

We have to look also at the current situation of too few students seeking to go into Pathology. In a few years there will be a lack of trained pathologists and the criteria for hiring will change.

I also see combinations of fellowships that are almost required...Hematology and Molecular pathology for example, going to major Oncology centers.

 

[Iceman24]

We've experienced this very thing in our practice, multiple times. However, the phenomenon of multiple fellowships I think can be attributed to a combination (and not of equal proportions) to 1) foreign medical grads looking to extend visa stays, 2) sub-par residency training such that graduating residents actually need additional training/experience at a real program, and 3) tight job market.

Everything sounds legit except #1 is the direct consequence of #3, it is so obvious...
Who would want to "extend visa stays" through the bloody useless fellowships if there would be an opportunity to do the same through the real job with the real attending salary, like trainees in other medical specialties normally do all the time?

 

[MetroPath]

There are programs out there with good Cytopathology departments and residents at these programs still do a Cyto fellowship to get additional training and board certification.

Some jobs require fellowships and if you aren’t fellowship trained in a particular area then no interview for you and hence no job for you in a tight job market.

Some places have good surgpath and residents still do surgpath fellowships at better more well known institutions like MSK or MD Anderson.

The default now seems to be 2 fellowships. Most people I know have done 2 although many have done 1 as well.